Email Discussion Group: Your EP Lab, Late Cases and Call

Readers, you can also go to www.eplabdigest.com and click on the email discussion group link. The website is always being updated, so check back often. We look forward to hearing from you! New Question: Your EP Lab What is the most frustrating problem you experience in your lab? If you had a "magic wand" to fix some problem in your lab, what would you change and why? What are your thoughts on how to improve staff and management communication? Jodie Elrod, Managing Editor of EP Lab Digest (Readers, to reply to this question, please type Your EP Lab in your subject line.) The problems we encounter in the EP lab are physician-related problems: tardiness, tardiness, tardiness. The magic wand problem is also a physician problem that is a real "twilight zone" of the "cardiac voodoo" speciality. You do not want to know, and I could not tell you anyway you would not believe it. We had an incident three years ago that might as well have nuked the lab. Time travel would be the only modality that might offer an alternative to the damage. Three years of therapy have only managed to keep post-traumatic stress disorder (a bull mastiff on a 12-foot chain) outside the EP lab door. We lost, in addition to the obvious, a respected physician and an employee to other lateral postings. We have given up on believing in a cure.  Staffing problems are you guessed it physician- and hospital-related. A busy qualified program has less problems. With two really good EP docs we had a very busy and "shocking" program that was fun and supported quality patient care. We still have two docs, but they are at opposite ends of the pendulum...of normal and super abnormal. This lab specializes in the peculiar, the strange and bizarre, and "where the hell did that come from?" Our staff is also that way. We have two part-timers, an FMLA diva, and two nurses suffering from ADD. Some of the ADD cultural, some biochemical, and like St. Jude's recall, part cosmic radiation. No, we have not resorted to wearing aluminum foil for surgical hats...yet. D. St. John, RN Under Discussion: Late Cases and Call How does your lab cover late cases? Do staff do call? How many staff are there per case? Kathleen MacDonald, RN (Readers, to reply to this question, please type Late Cases in your subject line.) For Electrophysiology Studies, ablations and implants, we staff with two RNs. We perform procedures in three different rooms. On a daily basis, we are staffed with a minimum of six nurses depending on the schedule, sometimes 7 or 8 nurses. 2 nurses work 6:30 AM - 4:30 PM 2 nurses work 7:00 AM - 5:00 PM 2 nurses work 8:00 AM - Late, these two nurses work until the cases are finished. There is no On-Call for us, we work 4 - 10 hour shifts, with both mandatory OT built in on the late nights; in addition, quite often when we are still running two rooms after 4:00 PM, the 7:00-5:00 nurses are asked to stay. We have on occasion held the 6:30-4:30 nurses when three rooms are still running. Louis Sabatino, RN Late cases and call is a very stressful subject. We have two labs: one cath and one EP/cath. We are open 7 AM until 7 PM weekdays. We have six full-time RNs, one part-time RN, and two full-time CVTs, as well as four per diem RNs. All take call once they are off orientation. We just had three staff members come into the call pool. One per diem is still on orientation. The full-time and part-time RNs do 10-hour/4 days. The per diems do 12 hours when they can. We like to have three RNs cover weekdays until 7 PM. We are take call for CPORT (acute MI) and call for IABP and temp pacemakers from 5 PM until 7 AM. We run three staff members during implants and the acute MI interventions. We have a problem with late EP/OR case and emergencies and how we cover late cases. Two RNs and 1 CVT take call every night weekdays and 24 hours each weekend day. We sometimes end up with our call staff doing the late ORs, which is very stressful to the staff. We have been running two rooms for about 14 months and have been very lucky that initially we hadn't had conflicts or our beepers went off at the end of OR cases. Recently, we have been much closer with the scrub and circ RN's beeper going off 3/4 into a case. The circ RN left the OR to set up the intervention, and luckily we had an RN on orientation who was coming in. We see this only becoming more of an issue because we often can't get beds for our ambulatory ORs and emergencies. Our institution is currently really tight with beds, and we have had nurses go home to then come back to relieve call nurses who had to stay with acute MIs in our holding room with a NA from another unit so she wouldn't be alone. We try to back each other up if we can, often with someone volunteering to be called back if there's a problem. Our Coordinator is aware when we have an issue and is available to us. Waiting for the EP MDs, who all work in multiple hospitals, can mean many of our cases are late. We are interested in what you do or if anyone has any good ideas. We anticipate rapid growth by the summer, when our lab opens up for unstable angina interventions and peripherals. We will eventually will have more staff, but until then, we have not come up with any creative ideas other than backing one another. Lynn De St Aubin, RN, Good Samaritan Hospital, West Islip, New York Late cases: Techs and RNs choose or rotate as the "late staff. They come in later and stay until it is over. Some cross-cover with/by/for cath lab RNs. No call: As an academic institution, emergencies are dealt with by the fellows (one is in-house overnight). There are very few instances of opening the lab overnight or on weekends (~once per year or less), so no formal call is needed. Staff per case: 1 tech, 1 RN, 1 fellow (usually), 1 attending. Bi-Vs and extractions and AF ablations "always" with two MDs. Anesthesia only for extractions and AF ablations. Everything else, including ICD implants and DFT testing % DCCVs, is IV sedation, which is great. John Fisher, MD, Director, Arrhythmia Service, Montefiore Medical Center and the Albert Einstein College of Medicine